NEI-NIH Funded Study Supports Link Between Uncorrected Hyperopia and Literacy Deficits in Preschoolers – Part 2

We reproduced a link to a landmark press release today from NEI-NIH in Part 1.  The release was based upon a study whose results were first presented at last year’s ARVO meeting.

Arvo Logo

We’ve long debated the significance of uncorrected hyperopia.  Many pediatric ophthalmologists and some pediatric optometrists feel that hyperopia needn’t be corrected unless a child is either complaining of headaches or if it is causing accommodative esotropia.  As reviewed by Donahue, only 33% of optometrists and 5% of ophthalmologists would prescribe glasses for a 6 year-old child having 3 to 4 diopters of hyperopia in both eyes.  Prior studies have shown that lower amounts of uncompensated farsightedness can interfere with literacy skills in older children, but this is the first multi center controlled study to look at the preschool population.  We can quibble over how much hyperopia is significant, and the fact that this study only looked at hyperopia under cycloplegia.  After all, some of these preschoolers in the moderate range under cycloplegia will have lower amounts without the drops in place.  That’s a discussion for another day.

Ophthalmology logo

The article based on the ARVO presentation by the VIP-HIP (Vision in Preschoolers/Hyperopia in Preschoolers) collaborative is now in press in Ophthalmology, the journal of the American Academy of Ophthalmology.  The test used in the study to probe the connection between uncorrected hyperopia and litracy is the TOPEL.


What’s the bottom line?  This now clearly turns the tables on the entire subject of Learning-Based Vision Problems.  Vision as an essential component of reading readiness is up for grabs.  Now included in the conversation about literacy has to be the impact of some relevant amount of uncompensated hyperopia.  That also opens up the door for more serious discussion about accommodative lag, and those children who didn’t read the book well enough to know that they can have decent distance acuity, but not sustain accommodation well enough to maintain focus at near with any reasonable efficiency.  No longer can these issues be dismissed by those who claim that optometrists “over prescribe glasses”.  The burden of proof has just shifted to practitioners who under-prescribe.  And by that I don’t mean cut the power of the Rx; I mean withholding a prescription altogether.  The bottom line just got a whole lot more interesting!Bottom Line Logo




6 thoughts on “NEI-NIH Funded Study Supports Link Between Uncorrected Hyperopia and Literacy Deficits in Preschoolers – Part 2

  1. Wham, bam, two great posts. Thanks, Dr. Press. So very basic: Garden variety hyperopia as a learning disability/physical disability. Those who think 3D hyperopia is nothing to worry about need to wear -3.00D for a day, or a week. We’re getting there, slowly.

  2. Dear Lenny,

    Some thoughts regarding this new and important information

    1) As in classic drug studies, which are done for a short period of time, but the results are extrapolated for decades and even patient’s lifetimes, we should extrapolate the impact of hyperopia on students beyond the preschool level. It should be a concern for each eye care practitioner who SEES a child that struggles in school.

    2) The older concept of hyperopia was based on concerns related to strabismus and amblyopia. This study has added another concern, learning.

    3) Research has one significant limitation. You need to minimize the variables. For an eye practitioner, who works with children, hyperopia is only one of the many variables. Deficits in binocularity, accommodation, ocular motilities, visual perception and other areas can also create obstacles, which can impair a child’s ability to achieve in a school environment.

    4) Visual attention is a very/very important component of learning and EYES are an important component of attention. Hyperopia and accommodative dysfunctions can cause a child to avoid focusing on an object or the print in a book for a sustained period of time. Any child with the diagnosis of ADD or ADHD deserves an appropriate eye exam. It is a better approach than a trial period of medication to help a child focus in school. Ritalin should not be the vitamin for education.

    5) It is important for each parent to listen to their child’s complaints, which can range from eye strain/fatigue, blurred vision, double vision, lose of place, skipping words or sentences, headaches and many other visual related complaints. They also should watch their child during visual activities. Does there child hold the book very close, tilt their head, close an eye, move their head when reading (type writer effect) and/or very short attention span. Although some doctors rule out eyes as a factor in reading, they should try reading with their eyes closed. They should watch and listen to their child (patient) read a grade appropriate paragraph.

    6) AND finally, it is time to put the child (patient) first. It is time to find solutions for children, who struggle in school rather than clinging to outdated policy statements. Vision is not the only factor in learning. If it is a factor, we should eliminate or at least minimize its impact on a child’s school performance. Learning problems require interdisciplinary thinking and/or an interdisciplinary approach. Vision should not be defined by reading an acuity chart at distance. 20/20 or perfect vision to some is an imperfect concept. It is similar to defining perfect health as 120/80. It is time for us to enter a new era in eye care and meet the needs of our children (patients).

    As always, THANK YOU, for sharing and informing us regarding changes in eye care and its implications on our lives and the lives of others.


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